Lateral Hip Pain

Tackle Your Pain

With Evidence

…and a good answer to the problem

This article discusses the evolving understanding of lateral hip pain/trochanteric bursitis and new exciting approaches to it’s treatment. It is deliberately written to be approachable, but also has links to the research articles from which the information is drawn if you fancy some deeper reading. Please also check out the links at the end to the many experts who work extremely hard to not only research these areas, but who also generously help to disseminate their findings.

Trochanteric Bur-WHATS-IT?

Trochanteric Bursitis is a common diagnosis for people suffering with lateral hip pain.

The Greater Trochanter is a small outcrop of bone on the side of femur (upper leg bone).

Normally tissue slides painlessly over the top of this boney outcrop.

A bursa is small fluid filled sack that forms between tissues that glide over each other; they are normal, useful and common in the body.

Bursitis is when this sack becomes irritated and filled with inflammatory fluid.

The Trochanteric Bursa sits just over the Greater Trochanter.

Trochanteric Bursitis used to be thought of as the primary cause of this painful syndrome, but as we will see, this is probably not the full picture.

What is Injection Therapy and why might I be treated with it?

Corticosteroid injections are anti-inflammatory and so can be used to help alleviate an inflamed bursa. They can be effective in the short term and in many people will give immediate symptomatic relief. They are useful, but also have drawbacks as they may have negative effects on tendons and it is noted that the beneficial effect is reduced in the medium term and may actually be less than no treatment at 1 year.

Steroid injections have their place, but there is a strong argument that they should primarily be seen as a short term pain relieving tool to be used when pain is a major limiting factor.

What's a Tendinopathy when it's at home?

Tendinopathy is a more current understanding of what we used to refer to as tendonitis.

There are subtle but important distinctions.

A tendonITIS means inflammation is the cause of the pain, whereas tendinOPATHY means disorder of the tendon. A tendinopathy is characterised by disordered collagen strands and an infiltration of small blood vessels, which causes the tendon to appear swollen.

When related to the hip, this is known as Gluteal Tendinopathy, and will often affect Gluteus Medius in particular.

and what is a Gluteal Tendinopathy?

This is a tendinopathy of your gluteal tendons and in many people is reason why the pain relief from the steroid injection either returns, or isn’t effective in the first place.

Gluteal Tendinopathy is now thought of as the primary cause of the pain as well as the bursitis. It is characterised by pain to the outside of the hip which may radiate down the outside of leg, or to the groin. It is often exacerbated by sitting or walking for long periods.

Gluteal Tendinopathy does not have to have an associated bursitis, but a trochanteric bursitis is rarely found without it.

1Keep moving! When we’re in pain, we don’t want to move, and sometimes rest can feel like the best recourse. Some rest, when the pain is too much is advisable, but constant rest will have a negative effect on the very structures we want to work on.

2Don’t stretch! Another myth is that the pain should be somehow “stretched out”, however, we now know that over stretching a painful tendon can be aggravating for it and can actually increase in your pain.

3Try an isometric exercise. Isometric exercises (muscle contraction, but with no movement) are proven to have a pain relieving component and are a great way to load the painful structures. See the video below

4Pace your self. The recommended loading is to occur at no more than 4/10 pain and with no increase in pain within 24 hours. Pain is not something to be afraid of, if it happens, don’t worry, you probably haven’t damaged anything. We just want to avoid continually overloading the painful structures. So a little ache is good and normal, lingering pain probably means you need to adjust to a lower load.

What Can a Physio Do?

At Heaton Moor Physio we are well placed to guide you through your progressive rehab programme.

Your physio will help to motivate you and keep you on track as you tackle this painful condition head on. They will also continually review your condition as a number of other problems may present with a similar pattern of pain, issues such as referred pain from the lumbar spine or muscular tears.

We will also encourage you to become more active as your pain subsides, helping you to tackle any metabolic reasons for your pain (article coming soon on this).

We will make sure that by the end of your rehabilitation you know as much about your condition as we do.

The real positive to the this approach is that you can be sure you are much less likely to suffer a relapse, and even if you do, you have the tools to be able to tackle it again.

STAY PAIN FREE

Gluteal tendinopathies are implicated in a number of common problems, including some knee problems, so understanding how to maintain your health in this region will help you live an active and fulfilling life.